Despite a significant improvement in safety standards in workplaces, it is a sad but unavoidable truth that accidents and injuries do occur often at work places. Hence, it is your duty to educate yourself about the various aspects and facets of workers comp. Read ahead for answers to common questions related to workers comp matters and issues.
Injured at Work—What to Do?
The first and most important step is to obtain medical immediately to minimize risk of complications. Once your condition is stable, it is time to report the injury to your supervisor/employer as early as possible. Whether the injury should be reported in writing or whether a verbal report is enough varies from state to state. To play it safe, it is best to make the report in writing.
This will ensure you don’t end up losing your right to workers comp after making a verbal report instead of a written one. Secondly, providing information in writing and keeping a copy of your report with yourself will help avoid unnecessary complications at a later date.
States often have a short deadline for filing of workplace injuries. Hence, make sure you file the report immediately after the injury, or, if you require medical treatment, then with minimal delays after receiving medical care.
Is it Mandatory to be Treated by the Company Doctor?
This depends on whether you are a federal employee or whether you are subject to state laws. As per FECA, you are entitled to seek treatment from any qualified doctor. Just keep in mind that law has imposed restrictions on obtaining treatment from chiropractors.
If you are covered by FECA and skip the company doctor option, then your doctor will have to submit medical reports providing necessary information required by workers compensation officials. This shall be considered the final report unless your employer seeks a second opinion. If the second opinion concurs with your doctor’s report, then the FECA compensation payments will continue.
If the second report is at a variance, then the workers comp office can, after assessing the medical evidence considered and other factors, choose to rely on the first or the second report. Or, the office can opt for a third report
If not covered by FECA and if subject to state laws, then this depends on the regulations framed by your state. Some states allow injured workers to seek treatment from their own doctors provided a written request to this effect is made before the injury. Generally, states require the injured worker to be treated by the company doctor for a maximum period of 30 days. After that, you are free to seek treatment from your own doctor. If the compensation payable to you is modified based on the second report, then you have the right to appeal against this decision.
Since the company doctor is recruited and paid by your employer or the insurance company, he/she may classify your injury as a pre-existing condition or may downgrade its seriousness. Considering the importance of the doctor’s report on the workers comp benefits you will get, it is not advisable to blindly trust the company doctor.
How to File a Workers’ Compensation Claim?
A workers comp claim is filed just like any other insurance claim—as a request to the insurance company for release of benefits. The first step is to inform your employer. Even if your employer learns about the accident from any other source, he/she is obligated to offer a claim form immediately. Since the obligation to provide benefits begins after completion of the claim form, your employer cannot withhold this from you.
You must fill only the Employee section of the claim form. It is imperative you fill the SIGN and DATE field in the form. Keep a copy of the filled form for your records and submit the original form back to your employer. If you prefer mailing the form to hand delivery, then choose the receipt requested option.
Once the form is received, the employer must fill the Employer section of the form and forward it to the workers comp insurer. You are entitled to a copy of the completed form. If you don’t get it, then make sure you request one in writing.
Generally, the insurer will revert with a status update on your claim within 14 days of receipt of the completed form. If you don’t get an update, then you should contact the insurer for information about the status of your claim.
What about Employers without Workers’ Compensation Insurance?
A few exceptions apart, all employers are legally required to obtain workers comp insurance. If your employer claims they don’t have this insurance, then you should either appoint a lawyer or contact your State’s Labor Department or Workers Compensation Office at the earliest.
For employers without insurance, injured employees can claim benefits from the fund setup by State Authorities for this purpose. Further, you can sue your employer for omitting to fulfill the mandatory requirement of obtaining workers comp insurance.
Is it Must to Hire a Lawyer?
This depends on the complications involved in your workers comp case. A straightforward instance of filing and acceptance of claim and release of benefits may not require the assistance of a lawyer. However, if you are confused or uncertain about the procedures, then hiring a specialized workers comp attorney in Atlanta can be very beneficial. It is best to appoint a lawyer if your claim has been disputed or the claim resolution is not to your satisfaction. Formal legal assistance can be very beneficial if your case is likely to be heard by an administrative or court judge.
How to Remedy Unsatisfactory Claim Resolution?
Federal employees covered by FECA can request that the Branch of Hearings and Review conduct an oral hearing or review of record of the Office of Workers Compensation Program’s decision. (OWCP). You can present oral or written evidence in support of your claim.
Or, you can make a written request to the District Office that made the decision requesting that they reconsider their decision. Such request must be filed with evidence that had not been submitted earlier.
The third option is to seek a review by the Employees’ Compensation Appeals Board (ECAB). Keep in mind this option does not allow you to submit additional evidence as the Board reviews the case only on the basis of evidence that has already been placed on record. Further, this option precludes further filing through the state or federal setup. The ECAB’s decision shall be final.
In event of a dispute of the claim by the employer, then you can seek a hearing before the Workers’ Compensation board followed by an appeal to a Workers’ Compensation Administrative Law Judge. In event of a negative ruling by the Judge, you can then file an appeal in the judicial system.
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